When to Seek Medical Care

Table 12-8 provides the symptoms, preventive measures, and selected treatment modalities for common training and mission-related musculoskeletal injuries. This list is presented for information and to help you determine whether you need to seek medical treatment. However, there arc numerous conditions which demand immediate medical attention.

Conditions Requiring Immediate Evaluation by Medical Personnel:

♦ Back pain that radiates into the thigh, leg or foot

♦ Joint dislocation

♦ Suspected fracture

♦ Any lower extremity injury in which the individual is unable to bear weight

♦ Pain which limits activity for 3 to 5 days

♦ Any hip pain which causes a limp

Table 12-8. Symptoms, Prevention, and Treatment of Common Training-and Mission-Related Injuries

Injury

Symptoms

Prevention

Treatment

Plantar Fasciitis

Pain In sole of foot just in front of heel; stiffness in sole with first steps of morning.

Stretch Achilles and foot after runs, hikes; massage sole of foot; firm shoes;1/4" heel lift; arch supports.

Stretch the Achilles tendon and foot on incline board; tape sole instep; massage, ice sore spot; place 1/4" heel lift in shoes.

Metatarsal Stress Fracture

Pain in long bones of foot, especially 2nd or 3rd; worse with weight bearing; aches at night.

Avoid training too much, too fast, too soon; take care when transitioning to new training surfaces (grass to asphalt); different footwear (old shoes, new boots).

Decrease amount of running or hiking; avoid full weight-bearing, use crutch or cane; seek medical evaluation.

Shin Splints

Pain at lower third inner tibia; worse with first steps of running or hiking; usually after long or hard runs or hikes.

Good shoe/boot wear; stretch before and after runs/hikes; pronators (flat feet) should use arch supports.

Ice to painful area before and after run, hike; ankle strengthening exercises, calf stretches, arch supports; medical evaluation for pain longer than 12 days.

Iliotibial Band Rub (ITB)

Pain at outside portion of hip or knee; gets worse several minutes into run.

ITB stretches; discard broken down shoes; use running shoes with wide heel base; check leg length differences.

Ice to painful sites. ITB stretches. Hamstring and quad stretches. Heel lift for leg length difference.

Table 12-8, Symptoms, Prevention, and Treatment of Common Training-and Mission-Related Injuries

Injury Symptoms Prevention Treatment

Muscle Cramps

Sudden severe pain in muscle belly, causing stiffness and loss of motion.

Maintain hydration/ acclimatization protocols; stretch at first hint of muscle tightness.

Grasp and tightly compress muscle belly with both hands; stretch muscle to maximum tolerable length until cramp resolves.

Achilles Tendonitis

Pain at back of heel along heel cord; worse with running and climbing.

Incline board stretch of Achilles; over-the-counter arch supports; stretch after all runs.

Ice for 15-20 minutes, every hour when possible; incline board stretch; cross friction massage.

Patellofemoral Syndrome

Knee pain localized under or around the knee cap; worse with going up/down hills or after prolonged sitting.

Quadriceps stretching/ strengthening exercises; hamstring and ITB flexibility exercises; check foot for biomechanical abnormalities (over pronation).

Ice and range of motion to acute injury; NSAIDs for 5 to 7 days; stretching/strengthening program. Arch supports or insert for over pronators.

Rucksack Palsy

Weakness, pain, and/or numbness of upper extremities or shoulders.

Correct load distribution; adjustment of straps as needed. Correct padding.

Avoid heavy load-bearing for 2 to 3 weeks; NSAIDs for 5 to 7 days.

Foot Blisters

Localized pain and redness: "hot spots caused by friction rub; clear fluid vesicle layer.

Shoe insoles (Spenco) Adaptive training to toughen skin; Change wet socks; Moleskin to blister-prone areas.

Cover blister with clean bandage and/ or moleskin; apply antiseptic to unroughen blister.

Table 12-8. Symptoms, Prevention, and Treatment of Common Training-and Mission-Related Injuries

Injury Symptoms Prevention Treatment

Ankle Sprain

Pain, swelling, loss of func- Ankle stretching and tion after turning flexibility exercises, ankle the ankle. braces.

If unable to bear weight, seek medical evaluation. Ice 20 min. every hour; compression wrap from toes to lower leg; leaving no gaps. Elevation: elevate foot 18" off ground; motrin, aspirin for pain; partial weight bearing using cane or crutch; seek medical evaluation for pain lasting longer than 3 days.

Medial Epicondylitis

Pain at inner bony aspect of elbow; worse with wrist extension.

Caution with aggravating factors: narrow-based hand placement for push-ups or wrist extension under resistance; generalized wrist-strengthening program.

Ice to bony prominence; wrist stretching/strengthening exercises; cross friction massage; avoid aggravating factors.

Heat Stroke

Hot, dry, flushed skin, high body temperature, altered level of consciousness, weakness, incoordination.

Hydration, stepwise acclimation to environmental conditions.

LIFE THREATENING MEDICAL EMERGENCY. Replace fluids; if possible, cool water immersion in the field; ice packs to arm pits, groin, temple; transport immediately to medical facility.

Heat Exhaustion

Cool, damp skin; nausea, weakness, fatigue, poor concentration.

Maintain hydration, during exercise in all weather; avoid Black Flag conditions.

Remove excess clothing, replace fluids, cool body with water immersion, ice packs, transport to medical facility.

Chapter 13

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